New research from Canada finds that teenagers who have suffered a traumatic brain injury, such as concussion, at some point in their lives are twice as likely to be victims of school bullying or cyberbullying. They are also nearly three times as likely to attempt suicide or be threatened with a weapon at school compared to peers who have never suffered such an injury.

Lead author Gabriela Ilie, an assistant professor at the University of Toronto and a
postdoctoral fellow at St. Michael's Hospital, also in Toronto, says not only are adolescents who
have suffered traumatic brain injury more likely to be victims of bullying, they are also more
likely to:

The study, published in PLOS One, is thought to be the first to give population-based
evidence of the extent of the link between traumatic brain injury and poor mental health outcomes
in teenagers.

Kids with traumatic brain injury are 'falling through the cracks'

Prof. Ilie says, "These results show that preventable brain injuries and mental health and
behavioral problems among teens continue to remain a blind spot in our culture. These kids are
falling through the cracks."

For their study, she and her co-authors used data from the 2011 Ontario Student Drug Use and
Health Survey (OSDUHS). Developed by the Centre for Addiction and Mental Health (CAMH) in Toronto,
the survey is one of the longest ongoing studies of schoolchildren in the world. It is completed
by nearly 9,000 children in Grades 7 to 12 attending publicly funded schools across Ontario.

Although it began as a survey of drug use, the OSDUHS is now a broader study of teen health and
wellbeing, and started including questions about traumatic brain injury in 2011.

Call to increase prevention of brain injury in young people

Co-author Dr. Robert Mann, director of the OSDUHS and senior scientist at CAMH, says they
already knew from a previous analysis of OSDUHS data that 1 in 5 teenagers in Ontario reported
experiencing a traumatic brain injury (TBI) in their lifetime. He adds:

"The relationship between TBI and mental health issues is concerning and calls for greater
focus on prevention and further research on this issue."

Prof. Ilie says teenagers already have a lot to deal with as they try to work out who they are
and what they want to do with their lives. Experiencing a traumatic brain injury can worsen any
behavioral or mental health problems they are already struggling with. Parents, doctors, teachers
and coaches need to be vigilant in looking out for young people with traumatic brain injury, she
urges.

Also, as many traumatic injuries occur while young people are engaged in recreation and sports,
the risk of having one would be much reduced if they wore helmets, and if practices like "body
checking" were abolished, says Prof. Ilie.

In Canada, ice hockey accounts for nearly half of
all traumatic brain injuries among children participating in organized sports.

Body checking is a technique used in contact team games like hockey, ice hockey, and lacrosse
where a player uses his or her body to disrupt an opponent's possession of the ball or puck.

In a
very fast game like ice hockey, this means the player can "slam" into their opponent with great
force. There are moves to abolish the practice - in May 2013 Hockey Canada voted to ban body checking for players
under 13 - because research shows it significantly increases the risk of traumatic injury.

Most of the funding for the current study came from the Canadian Institute of Health Research,
the Ontario Neurotrauma Foundation, the Natural Sciences and Engineering Research Council, the
Social Sciences and Humanities Research Council, Industry Canada and the Ontario Ministry of
Health and Long-Term Care.

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